MEDICARE: SOHO MEDICAL DOCTORS CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1447854146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOHO MEDICAL DOCTORS CALIFORNIA

Provider Business Mailing Address
First Line	:	12100 WILSHIRE BLVD FL 8
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7120
Country	:	US
Telephone Number	:	212-369-6757
Fax Number	:	212-369-3941

Provider Business Practice Location Address
First Line	:	12100 WILSHIRE BLVD FL 8
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7120
Country	:	US
Telephone Number	:	212-369-6757
Fax Number	:	212-369-3941

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. JACQUES JOSPITRE JR.
Credential	:	MD
Telephone Number	:	917-809-6259

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	02/18/2026

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